Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France.
Department of Radiology, Rennes University Hospital, France; University 1, Rennes, France.
J Gynecol Obstet Hum Reprod. 2022 Sep;51(7):102408. doi: 10.1016/j.jogoh.2022.102408. Epub 2022 May 16.
Endometriosis is a chronic inflammatory disease with a negative impact on fertility. The Enzian classification provides a precise description of deep pelvic endometriotic lesions, especially in the retroperitoneal area, from preoperative pelvic MRI scans. However, it is not known if it is correlated with postoperative fertility.
To determine if there is an association between the preoperative Enzian score and postoperative fertility after deep pelvic endometriosis surgery.
We conducted a descriptive, retrospective study using information from the ENDOREN database.
This was a retrospective study at the Department of Obstetrics and Gynecology at Rennes University Hospital (France) from January 2013 to May 2019 PATIENTS AND INTERVENTIONS: We used information from the ENDOREN database that included all women who underwent surgery for deep endometriosis and wish to conceive. This surgery was intended in a view to achieve a complete removal of endometriosis.
The Enzian score was calculated from preoperative MRI scans, and total, spontaneous, and after In Vitro fertilization (IVF) live births and pregnancies outcomes were collected from the patients'computerized medical records. Univariate and multivariate analysis was performed.
Sixty-eight patients were included. The live-birth rate was 35% (24/68). According to the Enzian classification, 25 patients (35%) were classified in compartment A, 64 patients (94%) in compartment B, and 27 (40%) in compartment C. In multivariate analysis, positive predictor of live birth was single Enzian B score (OR=4.7[1.21; 18.81], p = 0.03), negative predictors were uterine adenomyosis and a history of endometriosis surgery. In multivariate analysis, positive predictor of spontaneous live birth was EFI score ≥7 (OR =22.434; CI [1.138; 442.190]). In multivariate analysis, positive predictor was Enzian A score (OR=15.9[2.2; 114.7], p = 0.006), and negative predictors was uterine adenomyosis and Enzian B score (OR=0.01[0; 0.495], p = 0.02) for live birth after IVF.
The present retrospective study cannot strongly conclude about fertility and correlation with Enzian score because the groups are too small. However, it seems that when solely the compartment B is involved by endometriosis, complete full removal of endometriosis leads to better post-operative live births results. Other studies must be done to determine if Enzian classification based on preoperative pelvic MRI could be clinical value in the decision-making strategy for managing infertile patients with deep pelvic endometriosis.
子宫内膜异位症是一种慢性炎症性疾病，对生育能力有负面影响。Enzian 分类法从术前盆腔 MRI 扫描中对深部盆腔子宫内膜异位症病变进行了精确描述，特别是在后腹膜区域。然而，目前尚不清楚它是否与术后生育力有关。
确定深部盆腔子宫内膜异位症手术后，术前 Enzian 评分与术后生育力之间是否存在关联。
我们使用 Rennes 大学医院妇产科（法国）ENDOREN 数据库中的信息进行了描述性、回顾性研究。
这是 2013 年 1 月至 2019 年 5 月在法国雷恩大学医院进行的一项回顾性研究。
我们使用了 ENDOREN 数据库中的信息，其中包括所有因深部子宫内膜异位症而行手术且希望怀孕的女性。手术的目的是彻底切除子宫内膜异位症。
术前 MRI 扫描计算 Enzian 评分，从患者的计算机病历中收集总、自然、体外受精（IVF）后活产和妊娠结局。进行了单变量和多变量分析。
共纳入 68 例患者。活产率为 35%（24/68）。根据 Enzian 分类，25 例（35%）患者为 A 区，64 例（94%）为 B 区，27 例（40%）为 C 区。多变量分析显示，单因素 Enzian B 评分阳性是活产的预测因素（OR=4.7[1.21; 18.81]，p=0.03），负预测因素是子宫腺肌病和子宫内膜异位症手术史。多变量分析显示，EFI 评分≥7 是自然活产的阳性预测因素（OR=22.434；CI [1.138; 442.190]）。多变量分析显示，Enzian A 评分是活产的阳性预测因素（OR=15.9[2.2; 114.7]，p=0.006），子宫腺肌病和 Enzian B 评分是 IVF 后活产的负预测因素（OR=0.01[0; 0.495]，p=0.02）。
本回顾性研究由于研究组太小，不能有力地得出关于生育力和与 Enzian 评分的相关性的结论。然而，似乎当仅 B 区受子宫内膜异位症影响时，完全切除子宫内膜异位症可导致术后活产率更好。必须进行其他研究以确定基于术前盆腔 MRI 的 Enzian 分类是否在管理深部盆腔子宫内膜异位症不孕患者的决策策略中有临床价值。
